Dianne asks: What do you do when you are at the point of exhaustion and frustration, when you and the medical team are struggling to manage a patient who felt utterly unmanageable? A patient who is exhibiting behaviors indicative of borderline personality disorder (BPD)? What do you do when you and the medical team “cry uncle”—especially the lead doctors who have so many different feelings about a patient who is so provocative, a patient you watched struggle with her own cancer and ultimately, after a year and a half, died in the hospital where you work?

You decide to write about it and present at an AOSW conference: “When Staff Head to the Hills: Clinical Recommendations for Working With the Oncology Patient With Borderline Personality Disorder”

I wanted to present about this patient soon after she died. I was inspired by her and wanted to pay tribute to her in some way. I wanted to bring her to life for others, not just because of the challenges she presented to us, but also because of her strengths. I felt it would be helpful to me—to try to make sense of things for myself. And, maybe, I could help others better organize things for themselves and their teams if a similar patient were to come their way.

My friend and colleague Sara and I attended AOSW 2018 in Atlanta where I was a first-time poster presenter. We had been cheerleaders, critics and friends to one another leading up to and during the conference.

After Atlanta, my work with this same patient grew more intense. Sara had worked with a patient who presented similar challenges. Her patient, too, likely had a BPD diagnosis. In the summer and fall, we talked at length with our teams, supervisors and each other; we processed not just the actions of the patients, but also the staff’s and our own reactions. Sara came up with the fantastic notion of “Responding vs. Reacting,” and we would often help each other try to work that with our two patients. This idea of “responding,” i.e., checking our countertransference, is one of the key methods to working effectively with patients with BPD. From this idea of “responding vs. reacting,” we started to develop a framework for how to best care for our two patients, and the idea for our presentation grew.

Sara adds: AOSW 2019 was my fourth conference, and my favorite, although I say that about every conference! I presented a poster at AOSW 2016 in Tampa and, with five other oncology social workers, presented a Learning Institute in 2018 in Atlanta. There, Dianne and I began talking about the idea of co-presenting for AOSW 2019. Both of us tend to view challenges as opportunities for introspection and growth. We soon realized we could collaborate well on a challenging and under-represented topic. Dianne had been working with her patient for over a year when we decided to submit our abstract.

In our presentation, we illustrated the challenges a patient with BPD can present in an oncology setting.

Most health care professionals, including oncology social workers, have difficulty working with patients diagnosed with BPD. Along with others in the Cluster B category, these patients are characterized by dramatic, overly emotional or unpredictable thinking, behavior and interactions with others. We chose this topic because it is something that makes most of us uncomfortable and something we struggle with. Both of us felt challenged by our work with patients with BPD, but the challenges facilitated professional growth and a better understanding of how to better support our patients, our medical teams and ourselves.

Preparing the Presentation

What did our conference preparation look like? Even though we both work at Memorial Sloan Kettering Cancer Center, we work in regional sites three hours apart from each other. Most of the work was done virtually; we met in-person just three times.

Starting out, Dianne contacted our librarian to obtain journal articles we requested. Both of us shared the work of writing the abstract, which was quite challenging for us! We are both detail-oriented and thorough, which made it hard to keep the abstract within the word count limit. Once the abstract was accepted as a paper presentation, we began to feel excited and nervous.

We planned to cover four main areas in our presentation: how to recognize a patient with BPD/BPD features in your oncology setting, clinical skills for working with such patients, ways to assist medical team colleagues and self-care/burn out prevention for ourselves. Within these four categories, we created sub-categories. Dianne prepared her case study, and together we identified aspects of the case that highlighted important areas of the presentation.

The work of oncology social workers involves a strong and authentic use of self. Part of this, for us, involves using humor at appropriate times in our work. When Dianne used humor with her patient, it helped them connect. We were also able to weave humor and honest self-reflection into our presentation.

Preparing to co-present at AOSW is hard work—but the rewards are great. It is very much worth the blood, sweat and tears. If you are thinking about presenting, try to choose a topic of interest! We know it is very helpful to have a co-presenter—someone else who brings ideas that can both enhance and challenge yours. Choose a partner with a similar work ethic and style. And make sure that person is open to meeting for a couple of full Sunday work marathons. Organization is key—so be sure one of you is organized as there are several deadlines to meet.

No “work couple” is perfect, but balance is key. A little OCD with some self-care is an example of a good balance for co-presenters. (Dianne to Sara: “We need to see the room we’re presenting in as soon as we can!” Sara to Dianne: “Okay, that’s fine, but, no, Dianne, you do not need to read and review your note cards at 5:30 a.m.—you need to come hike with me!”)

And, like we did when working with our patients with BPD, use humor to decompress when the stress level gets high about the conference—and have some fun with it! (Dianne to Sara: "So, Sara, why did you decide to review your presentation note cards in 100-degree heat in the hotel lazy river in Tucson—when it was so hot that day the heat made your arms stick like super glue to the inner tube?!”)