Radiation therapists, workplace and culture

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I’m trying to write about radiation therapists. Not the tasks that we do, that’s pretty easy, although most people don’t have much of a clue. I’m trying to explain the relationships we have with each other and what our day-to-day working environment is like. I suspect both are unique. We’re not like our diagnostic radiographer colleagues who can work by themselves. We don’t do that. Our workplace culture is based on tight-knit teams—not only the doctor-physicist-therapist triad but the team that works on the treatment unit.

The closest model I can think of is an operating room. The nurses, anesthetists, surgeons have to work in a kind of dance. This dance relies on what Lorelei Lingard has called collective competence, being able to effectively work and communicate with others. Verbal interaction is key, most errors can be traced back to not talking to each other. It’s similar for radiation therapists. We have innumerable checks and balances, quality assurance steps and protocols, and many of them are verbal. But we also have to, fundamentally, have each other’s backs. It’s a dance of physical movement (moving the patient, moving the treatment couch, moving the equipment) and verbal interaction (I’m doing this now, this next, have you done that?). When we do it well, it flows seamlessly, between ourselves and the patient. When not done well it can cause friction, delays, a lack of patient care and, sometimes, errors.

There may be three of us on a treatment unit, or sometimes more. With breaks and shifts, sometimes just two at a time. If we don’t get on, talk to each other, the work gets harder. We don’t have a choice of who we work with, and we may be working with someone for months at a time. We sit close to them (the treatment consoles are small), check their work (and they check ours), lift and move patients together, and arrange our days (this patient is new, this one is finishing, we need to follow up on this, did you call about the weird noise the machine is making?) We have to trust each other, we have to know the steps.

If you work with someone like this for a few weeks, you often get to know a lot about them. What TV shows they watch, how their commute went, what they have for lunch, what their weekend plans are, their kid’s activities and their upcoming vacation plans. Between patients we chat, we get to know each other, we pass the time, we build our relationship. Our “private” and “professional” lives are not binary – they merge into each other. We need these interpersonal bonds when it gets stressful, when that patient breaks our heart a little, when we have to vent.  They can help sustain us. When we don’t get on, or when we can’t be ourselves at work, it makes what we do harder as well as less safe. The dance slows down, we stumble.

Why am I mulling this over? Because as I write my dissertation I’m remembering times when I was careful what I said at work, the religious co-worker who “didn’t approve of my lifestyle” and an older therapist who ignored my tentative coming out speech and referred to “my husband” (when he talked to me at all). I’ve had recent conversations with gay, bisexual and lesbian (GBL) therapists who have said they “keep themselves to themselves” at work, or “just don’t go there” with some people. There’s ample evidence that having to manage sexual identity at work (to monitor when it’s safe to come out) is common in healthcare, with colleagues as well as patients. GBL workers report more stress and less social support than their heterosexual peers. Covering up who they are is a reality for many, and they are less likely to talk about their partners or life outside work.

Does it matter for radiation therapists? I think it does. We’re not exempt from the same pressures that affect GBL physicians, nurses, pharmacists, other allied health care professionals and our trainees. I might argue that the way we work makes these issues more important. We need to be able to bring our full selves to work, to be able to fully join the dance.

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So this is Christmas – you should be writing

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This week I wrap up my narrative inquiry course and look ahead to the very last (!!!) class in January. We began the EdD last summer with a doctoral seminar (aka: this is what you are letting yourself in for, and here’s a film about Hannah Arendt smoking on a couch). This January’s class is the second and last doctoral seminar (aka: I hope you were paying attention because this shit is about to get real). In June we have “comps” (aka: stand up there and prove you know what you’re talking about, and we’ll let you do some research for reals). Just in case you thought it was smooth sailing after that, there’s the research proposal next and then the infamous institutional ethics hurdle and then…… we are deemed ready to go off and gather data followed by a long period of writing, crying and dark nights of the soul. Next, that fledgling dissertation runs the gamut of revisions and re-revisions before a final submission. Oh, and then a defense. But yay, last class….

The narrative inquiry course has solidified my thinking about how I want to do my research. I knew that my story would be part of the work, but didn’t have a good idea of whether that was possible. Now I do. I am going to write a series of stories using the data from my participants, and my narrative will be part of that. I’ve also become increasingly interested in poetry. I am thinking I might use it as several placeholders or introductions to sections in the writing.

The research is on “coming out”, I have been reflecting on and reshaping some of my memories – in part to prepare and practice. Here is a gift you didn’t know you wanted – a glimpse into negotiating LGB disclosure with patients having radiation therapy treatments for cancer.

Happy Christmas – see you next year!

 He is one of them and all of them, my next patient

The bluff King of Orangeville, or Orillia, or far away Bobcaygeon

Doesn’t like the traffic, supports the Jays (don’t we all) and this disease

This indignity has caught him, like a poleax, right between the eyes

He’s warming up on day 3, unlike my hands – but you know what they say

We cover the weather (seasonal), the traffic (catastrophic) and his daughter’s wedding

He needs a suit, the wife is asking if he’ll be well enough, will he, will he?

How about that diarrhea, that pain, will he last, will he last, what do I think?

I demur, I support, I encourage. I pat his hand as we leave the room

Not long, keep still, we can see you on the cameras, wave if you need us.

Then we’re back, he smiles – my girls, my girls, you take good care of me.

How lucky your husbands are, to have such kind and clever girls.

I pull up his pants; lift him as he grips me tight, catching his breath

He looks at my bare hand, smiles. I should introduce you to my son.

By the time the words come, he has left the room. Same time tomorrow.

I move the machine back around. Seen and not seen, there and not there.

The power of stories

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I’ve been thinking a lot about stories lately. After finishing (and loving), Frank’s “The Wounded Storyteller” I’ve been looking for restitution narratives, chaos narratives and the rest in the stories that I now see all around me. The approach of narrative inquiry rests on the foundation that life is storied; we make sense of who we are through reflection and telling tales. Also that the story and the Truth (in the pre-post-modern sense) may/will differ, and that there are thousands of versions of the truth – and they may change every time we retell our stories. Pretty intense for someone steeped in the world of “evidence” and the mono-culture that is modern health care.

Examples abound. I’m involved in a project to re-design our old “tick-box-Likert-scale” patient satisfaction tool. We read the literature on patient experience, talked to patients and designed it with some wide open space for people to tell us their stories. We’re told now that this is “hard to quantify” and “not useful for automatic data reporting.”  I’ve also been honoured to be reading a friend’s cancer treatment story, and to see firsthand how she (with grace and humour) finds meaning in her experience in her dual roles as radiation therapist and patient. The multiple points of connection with what I do at work (e.g. write recommendations for skin care for patients) with her lived experience (using a 99p pot of cream and some cabbage leaves) has shifted something fundamental and led to an opening of new possibilities. How can we move forward and reconcile, or entwine, these two viewpoints? How can we offer these stories to future patients and caregivers?

Moving focus to my reading at home/on the bus/at the hairdressers – the wonderful and painful memoirs of Jeanette Winterson and Dorothy Allison who literally write their way out of abusive childhoods that would break most of us. Both of them equate their ability to move through the world, and their subsequent success, with reinventing themselves through stories.

Compare this (from Winterson):

“I believe in fiction and the power of stories because that way we speak in tongues. We are not silenced. All of us, when in deep trauma, find we hesitate, we stammer; there are long pauses in our speech. The thing is stuck. We get our language back through the language of others. We can turn to the poem. We can open the book. Somebody has been there for us and deep-dived the words.” (P. 9)

To this (from Allison):

“The stories that other people would tell about my life….those are the stories that could destroy me, erase me, mock and deny me. I tell my stories louder all the time: mean and ugly stories; funny, almost bitter stories, passionate desperate stories – all of them have to told in order not to tell the one the world wants, the story of us broken, the story of us never laughing out loud, never learning to enjoy sex, never being able to trust and love again, the story in which all that survives is the flesh. That is not my story. I tell all the others so as not to have to tell that one” (P. 72)

Both authors talk about “writing over” – Winterson calls this a ‘fossil record” – a retelling of the same stories but the imprint of the common theme, the lesson, is still visible.  The words we chose, the language, has been used many, many times. No story is truly unique. They move us and teach us because we know them deep inside. Coming back to health care, Frank tells us that

“No story stands alone. Each story weaves threads that are original in that person’s experience. Yet everything that is said carries the resonance of previous stories, because every indignation and aspiration, every expression of despair and act of courage has been told before” (P. 220)

Whether it is published work, a blog from a friend or the stories of our patients – stories have power. And we ignore them at our peril.

References:

Allison D. Two or three things I know for sure. Plume. New York. 1995

Frank, A. W. (1995). The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Pres

Winterson, J. Why be happy when you can be normal? Vintage Canada. Toronto, Ontario. 2012