Nurses are an indispensable human resource in any hospital. It is safe to say that Malta has already had a taste of what such a nursing shortage could cause to its health department, as during the peak of the Covid-19 pandemic nursing staff was stretched to the limit.

Despite sometimes not being recognised properly for their hard work, some nurses are just happy knowing that they have taken good care of their patients and see them leave the hospital when recovered.

Oncology charge nurse Ronnie Frendo, 56, has been working in the oncology department for the past 32 years.

“I am very happy working here,” he told The Malta Independent.

Ronnie said that since his childhood he had always wanted to be a nurse and he would confirm this every time a teacher would ask him what kind of career he wanted to pursue. Working with oncology patients, some of whom are terminally ill, is not easy.

Nurses in this department are together with their patients from their very first appointment, and in some cases, depending on circumstances, they are also present when they take their last breath.

 

The patient’s experience

The patient’s journey starts with tests that lead to a diagnosis and this is where they are told what the situation is.

“If the cancer is in its first stage it is one thing but if it’s in its fourth than that’s another thing, as the more advanced the stage, the less effective is the cure,” he said.

He said that once all treatments, such as radiation and chemotherapy, stop working on the patient, then they would have to break the news. It is at this stage that patients start to be considered for palliative care.

Frendo said that in order to maximise their curability rate, people should go to a doctor as soon as they feel something is wrong with their body.

“When people discover they have cancer, it would have already been on them for two years,” he said.

He added that since a young age, children are thought that cancer is a silent killer as it does not show any sign of infection, unlike if one were to suffer from high blood pressure as effects such as headaches and dizziness are immediate.

One of the hardest news doctors and nurses have to break to patients is that of having to inform them that they have cancer. Ronnie adds that this would not be the only shock patients suffer, as the second one comes with having to tell them that they are going to be treated as palliative care patients.

“Although they would feel that their health is deteriorating, some of them would not be expecting it,” he said.

He added that apart from nurses and doctors, consultants, social workers and psychologists are all important to help prepare the patient “for this new stage in their life”.

Speaking about the patient’s reaction when they discover that the treatment is not working, Frendo says some of them cry, while others stare in the blank and are under shock, “that they do not understand two percent of the news they would have just heard, as after they start questioning the doctor”. He added that it is for this same reason, that normally these patients are asked to be accompanied.

In spite of having years of experience in the field, Frendo said that being present for such episodes, where the family is being informed about a relative’s cancer diagnosis, still affects him, especially when the patient is still young.

“Sometimes it is the children of patients themselves who tell us not to inform their parents about their diagnosis, as they know how they would react. In such circumstances we have always managed to find the right words to break the news slowly, using phrases like ‘you have a start of malicious tissue growth, which we need to treat’, always helps,” said Ronnie.

Asked how young children patients are given the news, Frendo said that “they have to be treated differently than if it were an adult”. He added that normally children are told in words they understand such as “now the doctor will give you something for the pain and it will not hurt anymore”, as the news in full will make sense to their parents.

 

Views on life

Speaking about his current role, Frendo said that his views on life in general have changed.

“Your views on life change when you work in the Oncology Department as there is no such thing as a guarantee on a long life,” he said.

In explaining the effects of being a nurse working in the Oncology Department, Ronnie said that seeing so many people dying especially young ones, leaves its marks. Despite this, he said that it does not hinder the quality of service and care which nurses and doctors provide, as if needed they can also benefit from the psychological services already being offered on site.

 

Patient’s mental health

On patient’s mental health, Frendo said that new patients are always confused when they come in for their first treatment, and that is why a warm welcome is always needed.

The first thing that the staff does to the patient is give them a “tour” of the facility together with an explanation of what they should expect. When giving these introductions, Frendo likes to add that “here there are people who love you and are going to take care of you”, as he noted that since nurses work in shifts, patients will be attended to by different nurses.

“We try to do our best in treating patients holistically,” he said.

Nurses are also provided with constant training opportunities in order to better their understanding of how they should respond to several situations. Although attendance is not forced, a large turnout number is always expected.

Frendo said that constant training is a necessity for nurses and they cannot permit themselves to fall behind, especially when considering that the experienced ones have to act as mentors for the new recruits.

Nurses try their best to make patients feel at home. “We try to joke between us and with patients without crossing any limits obviously and this has allowed us to create and maintain a family atmosphere,” he said.

As an example, he said that if they witness a patient having a rough day because of unbearable pain, the nurses go out of their way and start a conversation with them to try and distract them.

Although the option to sleep at the facility is always offered to patients who are in for very complicated and long treatments, Frendo said that he feels very satisfied, knowing that some of them do so willingly. He added that some patients have grown so comfortable with them that they even jokingly describe the experience as a “weekend break”.

In circumstances where the patient has no one to visit them, the nurses are known to give such patients extra attention, such as asking them if they want anything from the hospital canteen since they cannot go themselves. Although this is a very simple act, being offered something other than hospital food, can help boost a patient’s morale.

And when it comes to Christmastime competitions are held between wards at the Oncology Centre, where the best decorated one wins. Some of these decorations are handmade by patients themselves.

 

Effects of the nursing job on the individual

Frendo said that during the first period of his career in the Oncology Department it was very hard for him to process the death of a patient and he used to go in another room to cry.

This would be experienced on a deeper level emotionally if the patient in question would have been at the facility for a long time.

Despite the years of experience having made him a tougher person, the sight of a patient passing away still saddens him.

Mentioning particular experiences which have left an imprint on him, Ronnie recounts how during his earlier years, when the Oncology Department was still at Sir Paul Boffa hospital, he had witnessed first-hand, the level of desperation some patients find themselves in emotionally, while being treated for cancer.

“It was not the first time that a patient jumped out of a window to their death,” he said.

Frendo explained that nurses are instructed to inform the ward’s doctors when they find out that a patient wants to commit suicide, as they would need a referral to a psychologist.

He said that nowadays “you don’t hear much about this happening anymore”, as windows in the facility are locked, with only the security personnel having a key.