By Elaine Bruner, MSN, RN, CMGT-BC

Have you experienced a patient/family interaction you never expected? Growing as a case manager offers many of these moments but few have impacted me like a 19-month brain cancer journey with a Sailor and his loved ones. A cancer diagnosis produces a range of reactions and emotions. In 40-plus years as a nurse and case manager, I thought I was ready for any response. Well, I was wrong…let me tell you a story.

Sam experienced a severe headache and seizure a week before Thanksgiving. On Black Friday, he learned his diagnosis, glioblastoma (GBM). An incurable malignancy, the expected GBM prognosis is 12-18 months. Sam and his wife, Jill, displayed a measured reaction, asking about treatment options and how soon treatment would begin. Their teenage daughters were distraught, tears streaming down their faces. When offered a prognosis, Sam declined to hear a timeline and throughout his multiple treatments, he never asked, “How much time do I have?” Sam’s unwavering Catholic faith was evident, as he often repeated, “This is the journey God gave me.” No expression of anger; just acceptance that this was God’s decision and he would accept it. Sam’s immediate and extended family embraced the position that you don’t receive more than you can handle. I was stunned…then I recalled the Navy Creed that was Sam’s life. “I will never quit. I persevere and thrive on adversity. If knocked down, I will get back up, every time.  I am never out of the fight” are phrases from that Creed. The GBM was Sam’s enemy and his fight.

During months of treatment and declining functional abilities, Sam and Jill made six-hour round trips for neuro-oncology appointments. During one of these long days, I joined them and witnessed another coping strategy for Sam. Apparently, it was routine to have the largest, sloppiest burger and a dark beer after his appointment. Good news, or bad, Sam relished that burger and beer. 10 months before he died, Sam lost the ability to speak. Aphasia did not preclude the burger and beer routine. Until he entered hospice and had virtual appointments, Sam ate a double cheeseburger with bacon, a fried egg, and all the condiments. His facial expression was pure joy as he drank his favorite dark beer while relishing the burger flavors.

What did I learn from Sam?

1-For people facing catastrophic illness or injury, Faith may be as essential as any treatment.

2-You are who you are until you are not. Sam’s resilience never wavered.

3-A good burger and a beer make any day better. He was a wise man. 😊

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Bio: Elaine Bruner is an experienced nurse, case manager and educator. She completed her undergraduate studies with the State University of New York at Platttsburgh, followed by her graduate work with the University of Virginia. Prior to entering case management practice, Elaine worked in diverse settings including oncology, nutrition support, home health, and traumatic brain injury rehabilitation. Case management offered Elaine opportunities to join transdisciplinary teams in cardiology, critical care, and ambulatory care. Since 2008, she has been associated with American Nurses Credentialing Commission, contributing to the Nursing Case Management (NCM) certification review products. She co-authored the 4th edition of the NCM Review and Resource Manual, with Peggy Leonard, and was the faculty for live workshops and webinar presentations. Elaine embraces her educator role, authoring manuscripts in CMSAToday, offering continuing education presentations, and coaching case managers to certification success. Elaine's current role, with US Navy, offers daily challenges, keeps her skills sharp and a smooth transition to retirement.