A Unique Privilege: Social Work in a Cancer Institute- Part Two
An interview with Elizabeth Agnello, MSW student
by Pat Shelly
This post of the interview, conducted in February 2014, is continued from Part One, published March 27th.
Elizabeth (Lizzie) Agnello is now in her last semester and will receive her M.S.W. degree in May 2014. She also holds a M.A. in Japanese Literature, and speaks Japanese, Mandarin, Italian and Spanish. Since September her field placement has been at Buffalo’s Roswell Park Cancer Institute (hereafter referred to as “Roswell”), a national leader in cancer care. Lizzie is in the Psychosocial Oncology unit at Roswell, which addresses the social, environmental and emotional impact of cancer on peoples’ lives.
Tell us about your field educator/supervisor.
Glenn Frost, LCSW is my supervisor and field educator at Roswell. He is a Medical Social Worker, and also a UB School of Social Work alumnus. (Note: As an adjunct faculty member, Glenn has taught Social Work Interventions and Professional Development Seminars at UB.)
What did Glenn teach you that has helped you in addressing the reality of cancer and serious illness?
Early on, my supervisor took told me two things about this:
First, the best way to really learn how to be helpful to patients is by doing. I shadowed my supervisor for a few days when the placement first began, then he encouraged me to find what works for me – to discover my own way of entering a patient’s room and initiating the conversations we would have. When I begin talking with patients, they will know whether or not I am coming from a genuine place.
Second, he taught me that we are here to validate our patients’ feelings and to give them permission to feel and choose to do whatever it is they want – it is our role to help them make meaning of the illness, and to re-frame their notion of hope in the context of what they are enduring daily. I began to meet the patient where he was and became more aware of the meaning behind what he was sharing with me.
What is special about social work in a cancer institute and in end-of-life care?
American society has only recently awakened to the special needs of the dying and their loved ones. Too often I have found that loved ones do not have the support they need and thus they are left mostly to feel without hope. At Roswell Park, end-of-life care addresses the need for healthcare providers to develop expertise in the psychosocial, ethical, and spiritual aspects of dying. Roswell also asks that patients are well-informed to consider the option of palliative care work or comfort care (a key department at Roswell) to ensure as little discomfort or pain as possible in their last days or months.
Being present with a person at this critical period in his life requires us to apply key skills that we have learned during the MSW program. It is a unique type of caregiving and relationship-building with active listening and a person-centered, strengths-based approach. These skills include cultural competency regarding attitudes and practices concerning sickness and death. With training and the cultivation of compassion, we can bring much wisdom and sound practicality to this powerful time in someone’s life, and help transform the quality of countless lives – and deaths.
What would have helped you to know before starting in this specialty? Any advice for future MSW interns starting at Roswell?
I would have liked to have greater depth and breadth of knowledge of medical oncology terminology before beginning my placement.
My advice to future interns: Like so many experiences during your time in the School of Social Work, you will only get from this internship what you are willing to put into it. This is an incredible time of self-discovery – so be unafraid to create experiences/opportunities for yourself; they may seem daunting at first but this is the best way to learn in most social work settings.
Work hard to develop awareness of transference and countertransference which is so important in this setting; pay close attention to the cues that patients offer, and allow the conversation to develop from there.
Often this means sitting in silence with the patient after they offer a profound statement. For example, I entered a room once and gently asked a patient, “how are you feeling today?”, to which he replied, “not bad for a dying man.” This offered an opportunity for a powerful re-frame but I think, more importantly, it demanded a pause in the conversation for both of us to be able to reflect upon the statement and carry the conversation forward from there.
You have to be very present for the patient in that moment to be able to know how to proceed. I think as we put ourselves in this situation more and more, we gradually become one with whom the patient feels at ease to open up with rather than shut down further in front of and there are fewer silences. I have even made many patients smile and laugh as they tell me stories of their lives. So much of what we do is about hope at a time which is about redefining hope and, for the patient and families, can sometimes feel devoid of hope.
Do you have suggestions about what training would be helpful for future MSW students?
In the 1990’s, Joan Halifax established “The Project on Being with Dying” to provide end-of-life care education and services based in a compassionate and contemplative approach. I have tried to apply these points in my internship at Roswell. I will continue to need to gain skills in this “being”. One huge part of the learning process at Roswell has been becoming more familiar with the psychosocial and spiritual responses to dying, and then to effectively and sensitively respond to individuals touched by death.
The sheer level of stress that families experience during the time of diagnosis and treatment is immense. One of our roles is to help relieve that stress and sometimes this involves merely allowing them to verbally release their fears and uncertainties in a verbal fashion. The power of anticipatory grief is quite profound and can alter one’s life in many ways.
One patient’s partner shared that he had been absent from work for several days on end due to the fact that he did not want to leave his wife home alone. This was not just for safety reasons but also because he did not want to be away from her for even a moment. Talking with bereaved people and helping them search for and make meaning of their experience, especially in the first year after a loved one’s death, is crucial. The meaning-making process actually builds hope for them, allowing the loved one to gradually move forward with his life and to bend but not break when they think of their loved ones who has recently passed.
What is your self-care program?
I play golf, do yoga for golfers, cycle, write poetry, engage in mindfulness meditation and spend time with people who make me laugh for self-care. I find that these activities redirect my heart and mind to a place which is genuinely reflective and in which my thoughts flow through me freely and I do not judge them.
These practices also keep my mind focused on what truly matters, such as family and maintaining a positive outlook. Also, I think these forms of self-care enhance my ability to stay present with all patients and in life in general. They also decrease the risk of experiencing vicarious trauma when sitting across from a patient.
Finally, where would you like to be in five years?
In five years, I would like to be a pediatric oncology social worker at the University of North Carolina-Chapel Hill Medical Center in Chapel Hill, NC.
I can see you there! Best of luck and thank you for sharing your insights and your internship experience with us.
Note: In April 2014, Elizabeth Agnello was named as the recipient of the 2014 NASW Award for the University at Buffalo School of Social Work. This award was established by the New York State Western Division of the National Association of Social Workers (NASW), to be given to a Masters level student who has demonstrated academic excellence and personifies the values of the Social Work profession as defined by the NASW Professional Code of Ethics. Nominations can only be made by faculty. Congratulations to you, Lizzie!
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 this field of practice?
We’ll publish your replies as an addendum to this post.