Today I’m outside the interventional radiology hallway waiting for one of my patients to come in for a biopsy. This is a patient who had a lumpectomy and radiation four years ago and has been on endocrine therapy to prevent recurrence. Now she has had some abnormal imaging, thus the need for a biopsy. I know she will be thinking the worst and be very scared—so I’m waiting to give her a hug and some positive thoughts. Her face lights up when she sees me. Later she emails me that everything went well. It is moments like these that make me glad I decided to become a breast patient navigator.

I knew very little about what a navigator did when the doctors I worked with thought it would be a perfect fit for me. That was more than seven years ago! They took me under their wing and taught me the care paths for patients with breast cancer. There was a lot to learn, even for a seasoned medical social worker. There was also a very stressful certification exam, but I don’t like to think about that. And then, I was a certified navigator! And with that came abstracting, Excel spreadsheets, and reporting to our Breast Leadership Team and Cancer Committee Chair. Ironically, the paper and detail work didn’t bother me because I always liked reading medical records and documenting—these new tasks were just an extension of that.

I would spot patients who missed or cancelled their testing and follow-up appointments. My patients got used to me calling and encouraging them to come back in and “just discuss…natural treatments…radiation therapy…endocrine therapy….chemotherapy…with the doctor.” My social work counseling skills came in handy. I was also very good at identifying the depression, anxiety and fears that prevented patients from following up. Referrals for counseling, support groups, financial assistance, housing, transportation, talking to children, fertility preservation, etc. were already part of my toolbox! I had a very good success rate in helping patients get through their treatment plans. When a difficult case was being discussed in tumor board meetings, the doctors would often say, “We need you to work your magic.”

You and I know there is no magic. It is the empathetic listening, nonjudgmental support and goal setting that we learned in graduate school. No surprise that being a good social worker helped me to be a good navigator. Despite this, there is the frustration of patients who decline therapies that are the standard of care only to have a recurrence months later. I respect their right to self-determination but inwardly cringe because of what I know. There is also the heart wrenching pain of a longtime patient who did “everything right” have a recurrence or find they now have metastatic disease. The tears are not only theirs when I need to help them transition to palliative or hospice care,

There are times when I feel I am glued to my computer, especially when a survey is looming. But for the most part, I have a nice mix of meeting new patients, seeing post-op patients in the hospital or receiving chemo and radiation as outpatients. I still run my Breast Cancer Book Club support group and bring in new patients who need extra support to meet those who had been “survivors” for years. And every year when I walk in the Making Strides Against Breast Cancer walk with my colleagues and patients, I count my blessings in being able to work with amazing and courageous women every day.